Tolerance of baked-milk in milk-triggered children with eosinophilic esophagitis (EoE)

Abstract

RATIONALE: Eosinophilic esophagitis (EoE) is likely to recur when medicine or diet treatment is discontinued; thus, adherence to long-term therapy seems critical. Some EoE experts have recommended basing therapy on patient preference and available resources. Our goal was to develop a decision aid tool (DAT) for EoE in order to educate patients/ families about treatment options and involve them in choosing a therapy consistent with their personal values. METHODS: Twenty EoE patients were randomly assigned to one of two study groups to complete a DAT or receive verbal information describing treatment options. After this intervention, patients/families chose to start treatment with cow's milk elimination diet or swallowed corticosteroids. Symptoms were reassessed after 8 weeks, and the results of repeat biopsies were reviewed. RESULTS: Five patients (25%) chose treatment with cow's milk elimination and 15 patients (75%) started swallowed fluticasone. Treatment choice was not related to study group (p50.9). All together, 16 completed a second study visit (n513) and/or repeat esophagogastroduodenoscopy (n513). Most patients who returned for follow up reported that symptoms were at least somewhat improved with treatment (12/13). For those who had repeat esophageal biopsy, histologic remission (i.e. <15 eosinophils/ high power field) was noted in 7/13 (54%) with 5/9 (56%) taking swallowed fluticasone as compared with 2/4 (50%) who had removed foods with cow's milk from the diet (p50.9). CONCLUSIONS: In spite of offering the simplest dietary treatment for EoE, the majority of our patients preferred starting medicine. Histologic remission was challenging even in the setting of close follow up and individualized treatment plans.